Women should be able to find and use a contraceptive method of their choice, and self-injection with DMPA may be an appealing option for those who want to manage their own reproductive health. Photo: PATH/Will Boase

Recent evidence on self-injection of a new injectable contraceptive called subcutaneous DMPA (DMPA-SC) is providing one possible answer to an age-old question in family planning: How do we address barriers that make it difficult for women to keep using contraception consistently?

According to three recent studies, women who self-inject with DMPA-SC in their own homes or communities may continue using injectable contraception longer than those who receive injections from providers. In many Family Planning 2020 (FP2020) countries, injectable contraception is already popular, but often requires women to return to clinics every three months for injections. This can pose a significant barrier to consistent contraceptive use, especially for women who live in rural and remote areas. These new findings on self-injection should be very good news for women who like injectable contraception—if the global FP field has the courage to put this option for pregnancy prevention directly in women’s hands.

Health advocates have a long history of increasing access to lifesaving products, especially for women and children, by affecting policy change. But what happens when, once adopted, the national policy doesn’t translate into increased product access throughout the country? Policy change alone is not always sufficient to achieve improved access to health products. However, advocates have an important tool at their disposal to complement policy change: market advocacy.

The patch's microneedles penetrate the skin only slightly, causing less discomfort than traditional syringes. Photo: Georgia Institute of Technology.

The use of microneedle patches as a drug delivery platform has received a lot of media buzz of late. The concept of microneedles is actually several decades old. It has taken relatively recent advancements of microfabrication technology and manufacturing techniques to move the concept to reality. Today, this cutting-edge technology is being evaluated—and in some cases already being used—for diagnostic purposes and to deliver drugs, vaccines, and biotherapeutics. Indeed, the use of microneedle patches to deliver vaccines could be a major breakthrough impacting global health.

Begin with the end in mind. A phrase that is frequently used, it can mean different things in different contexts. In the field of contraceptive research and development, we often use the phrase to highlight the importance of keeping the needs and perspectives of potential end users front-and-center as we design, test, and evaluate new products. This means incorporating acceptability research into all phases of product development—as we brainstorm ideal methods to fill gaps in the method mix; shape and refine Target Product Profiles for new methods under development; conduct pre-clinical and clinical research; and develop strategies for product introduction.

Advocates hope to see a range of female condoms available in the United States and abroad. Photo: PATH/Danny Ngan

One small rule change being considered by the United States Food and Drug Administration (USFDA) could make a big difference in the pregnancy and HIV prevention worlds—and could expand female condom options available to women, men, and young people.

The female condom is a valuable prevention tool that should be offered as part of a wide method mix. It is the only option available today that protects from both unintended pregnancy and sexually transmitted infections (STIs) and is designed for women and receptive partners to initiate.

Why do women who do not want to get pregnant choose not to use modern family planning methods? While this question is not bounded by geographies, the most recent Guttmacher Institute report, which focused on the low- and middle-income countries, is most illuminating. The two most common answers given by married women were health reasons/side effects or fear of side effects (26%) and claims of infrequent sex or not being sexually active (24%). Among unmarried women, infrequent sex (49%) was the top reason.

Equally informative are recent FHI 360 findings from a user preference study in Uganda and Burkina Faso showing that 75% of women currently using a method would be open to trying new technologies. It quickly becomes clear that existing methods do not satisfactorily address the changing needs of women throughout their 30- to 40-year reproductive journey.

Not to be forgotten, male contraceptive methods remain limited, even though acceptability research indicates that a substantial number of men would use family planning options themselves, if available.

Tutorat—the French word for “tutoring.” Even the name of this training approach shirks the limelight. But it’s hard to argue with results, which are exactly what Tutorat has been delivering for health care in Senegal.

When I sat down with one of the pioneers of this approach, Dr. Boniface Sebikali, IntraHealth International’s senior clinical advisor, it became clear that Tutorat is something special. It’s quietly revolutionizing health care in Senegal and making higher quality services available to more communities than ever.

Since I was nine years old, I have been telling my father that I will be the first woman president of my country. The Democratic Republic of the Congo (DRC) is vast — almost the size of an entire continent. And if I were president, I would be able to change so many things for youth, with just my signature.